Creating Adjusted Scores Targeting mobiLity Empowerment (CASTLE 1): determination of normative mobility scores after lower limb amputation for each year of adulthood.

Abstract

As United States healthcare transitions from traditional fee-for-service models to value-based care, there is increased need to demonstrate quality care through clinical outcomes. Therefore, the purpose of this study was to create equations to calculate an expected mobility score for lower limb prosthesis users specific to their age, etiology, and amputation level to provide benchmarks to qualify good outcomes. A retrospective cross-sectional analysis of outcomes collected during clinical care was performed. Individuals were grouped based on amputation level (unilateral above-knee (AKA) or below-knee (BKA)) and etiology (trauma or diabetes/dysvascular (DV)). The mean mobility score (PLUS-M® T-score) for each year of age was calculated. AKAs were further stratified into having a microprocessor knee (MPK) or non-microprocessor (nMPK) for secondary analysis. As expected, average prosthetic mobility declined with age. Overall, BKAs had higher PLUS-M T-scores compared to AKAs and trauma etiologies had higher scores compared to DV. For AKAs, those with a MPK had higher T-scores compared to those with a nMPK. Results from this study provide average mobility for adult patients across every year of life. This can be leveraged to create a mobility adjustment factor to qualify good outcomes in lower limb prosthetic care.